the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Case Study - 'Always on a catch-up'
‘Always on a catch-up’: joint working across the police and mental health
This case is about the partnership working involved in a Police Liaison Committee (PLC) working in a specific area. The committee involves the police together with health and social care professionals and users/carers involved in the local Mental Health Trust. This PLC was formed from two previous committees covering north and south of the borough, and has been in existence for around 15 years. In the last couple of years, Nicola, a manager in mental health, has taken on chairing the committee and this case takes up the PLC story from that point on.
This partnership works with the tension that society places on the police and mental health professionals of safeguarding the public while achieving the integration of people with mental health problems within the community. At the same time key national policy concerns for the police prioritise their crime prevention and detection role through strict targets alongside their role in public safety. Resource pressures predominate. Both NHS and social services staff also experience the target culture and the pressure on resources this has produced as well as the tensions of achieving appropriate risk assessment as well as good clinical practice for people with mental health problems. Bringing all these tensions together in the PLC sharpens the issues and emphasises the different cultures of these agencies. How the police support the Mental Health Act assessment process is one key activity the committee addressed.
People in this case
From the police:
Mike is a Chief Inspector and the senior management lead on mental health for the borough.
Dan is a Police Sergeant working in the integrated borough operations office where requests for help on mental health issues are routed initially
Bill is the Beat Officer for the area where the key mental health hospital and related services are located.
From the Mental Health Trust:
Nicola manages a Community Mental Health Team. She is chair of the Police Liaison Committee
Janet is the Mental Health Trust’s specialist nurse advisor on violence
From Social Services:
Mo is a Senior Social Services Manager and the Local Authority lead for mental health. His line manager is a health employee and the Borough Director for the Integrated Mental Health Service. He is located in the hospital where he is also the Trust’s social work lead.
Also useful additional explanation related to this case about embedding change PPTor PDF
RESEARCHERS' Commentary
This case shows the power of professional cultures in the partnership process. It illustrates how leadership that recognises and works with professional cultures can build partnership, coupled with the need for procedures to back up informal working processes and embed partnership. It also illustrates the limits of a formal committee structure in communicating to staff on the frontline and how this kind of structure must work hard to take its learning and embed it within constituent organisations. It also raises questions about how best to involve users and how to reconcile local action with national policy changes.
Embedding partnership working
People’s views on what strengthened and could further strengthen the partners’ joint work clearly fall into either procedural or cultural approaches to embedding change. (See Marsh and Macalpine 1995 Our Own Capabilities, King’s Fund ).
Procedural approaches included:
- clarifying terms of reference and membership;
- establishing a single point of contact within Health;
- working to achieve a more equal representation between the Police and the other bodies (see especially Mike’s story link here);
- collating information and presenting it to others where there are problems;
- the partnership prioritised building common procedures and agreements about joint approaches to clients/people with mental health problems.
But sometimes these did not work: ‘Plus on the wards they should have the joint protocols with the police, but no one ever knows what they are or where they are.’ Beat officer (Bill’s story) Notably people from the police are keenest on procedural approaches since this fits their own working culture.
Cultural approaches help people see the point of procedures and to use them, also to develop commitment to the aims of joint work and appreciate others’ perspectives. Here aspects that worked on cultural embedding include:
- Building shared experiences, e.g. staying for a cup of tea; police ‘had their eyes opened’ when they heard how few powers Health staff have (link this to Janet’s story); Nicola knowing about police experiences through her two brothers in the police
- Spending time outside formal meetings; the committee absorbs quite a lot of energy: ‘we constantly have to put in work to keep it afloat and working effectively.’ (Mo’s story)
- Having a positive approach: ‘We try to support people’s good intent and understand their pressures.’ and ensuring positive feedback is shared (Janet’s story)
- consistently doing face to face work – for health and social care ‘continuity has helped us get it together as a group’, compared with the police where those attending tend to change. ‘How important a role individuals play in making joint working work.’ (link to Mo’s story) The committee offers a face-to-face opportunity for people from very different cultures to explore what they are trying to do and create shared processes. The importance of physically meeting each other and experiencing each others’ different realities helped the difficult process of creating shared meaning. (Follett cited in Maddock and Macalpine 2006).
Notably these points come mostly from the health and social care people.
Professional differences
The story shows extreme differences between the professionals involved and their professional cultures and assumptions. Some examples include:
- risk ‘assaults on staff which they are complaining about and which I think we could do more to deal with through prosecuting people’ (Bill, beat officer) vs. ‘sometimes the police were heavy-handed, sending far too many people when they didn’t need to and vice versa’ ( Nicola, joint committee chair )
- silence on some issues ‘doctors don’t want to comment on violent patients …a nurse was bitten badly by a patient ..the psychiatrist would not comment on it.’(Bill, beat officer) vs. myths about what mental health staff can do and ‘in fact staff are pretty vulnerable and often unable to act’ (Janet, nurse advisor)
- meetings culture: how lateness is viewed, how items are raised and how far action is taken (see differing views of Bill, Nicola and Janet)
The policy to integrate mental health services in the borough across health and social care had been pursued largely without linking the police in, although they are key stakeholders. On the other hand the police also made major decisions without consulting mental health colleagues. The joint committee experienced shared training and visits to each other’s work as helpful ways to combat these difficulties as well as their actual meetings.
Leadership
The key role of Nicola and her approach as chair of the joint committee shines through this story. Not only is her approach key to ‘getting more of a grip’, as Mike put it, in terms of the procedural issues described above, but she also develops the connections between people that help reduce the cultural and professional barriers. She develops work between meetings (see also Hope in the Sure Start story) and helps the joint committee forge other links through training and visits. These help her create more ‘common ground’ as Janet terms it and achieve shared meaning between the members. Nicola’s leadership is appreciated and is seen to emphasise the key role of individuals in partnership (link to Mo’s story).
However the story also highlights the difficulty of relying on the leader. There is a gap in transmitting the joint committee’s good work further into member organisations. How can the member organisations really learn and use what their representatives achieve in their joint forum? The need for more communication ‘downward’ is clear from both Bill and Janet. Bill is especially frustrated as a front line worker that little from his perspective has changed; while managers feel a lot has changed.
Involving users
The story also raises the tensions of involvement of users in the joint committee. While there is a positive perspective from police (‘a good thing’ Mike) and mental health professionals: ‘bring in a useful perspective, especially the emotional dimension of what the work is about and the issues of patient to patient violence, not simply patient to staff’ (Janet) the committee experiences the difficulty that some users focus on their (out-of-date) personal issues. A positive approach within the mental health trust of a ‘pyramid’ i.e. engaging a lot of users at the base of the system and also training representatives and carers – formed an infrastructure the joint committee could draw on.
National policy: local implementation
Finally the story illustrates some key tensions in national policy affecting local action: the local training is stopped due to national changes; national police targets make unhelpful local changes. Overall the people involved struggle with how to act to reconcile a high profile national level ‘hot topic’ i.e. mental health and public safety with a humane local response to individuals in distress, severely ill or at risk. This raises issues of how partnerships can explicitly develop joint purposes and values and hold onto these in a setting of pressurised national policy developments.
Read or download a PDF of all the stories in this case study. Also useful additional explanation PPT or PDF